Mrs Mary Beth Russo Blackwell, LCSW | |
220 Arlington Way, Ormond Beach, FL 32176-8164 | |
(913) 709-3209 | |
Not Available |
Full Name | Mrs Mary Beth Russo Blackwell |
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Gender | Female |
Speciality | Social Worker - Clinical |
Location | 220 Arlington Way, Ormond Beach, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1063731263 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | SW18791 (Florida) | Primary |
Entity Name | Refresh Canopy Cove, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1730661752 PECOS PAC ID: 3779822119 Enrollment ID: O20190304000354 |
Entity Name | Optum Behavioral Care Of North Carolina, P.c. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1033984448 PECOS PAC ID: 5092120030 Enrollment ID: O20240401000110 |
Mailing Address | Practice Location Address |
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Mrs Mary Beth Russo Blackwell, LCSW 220 Arlington Way, Ormond Beach, FL 32176-8164 Ph: (913) 709-3209 | Mrs Mary Beth Russo Blackwell, LCSW 220 Arlington Way, Ormond Beach, FL 32176-8164 Ph: (913) 709-3209 |
Sara Mousikos, Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 454 S Yonge St, Ormond Beach, FL 32174 Phone: 772-453-8119 | |
Ms. Tanya Allen, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 285 Clyde Morris Blvd Ste 300, Ormond Beach, FL 32174 Phone: 239-690-6906 | |
Gwen H Kotler, MSW,LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 533 N Nova Rd, Suite 203, Ormond Beach, FL 32174 Phone: 386-334-8430 | |
Mrs. Brittany Sweeting, SW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 98 Bella Vita Way, Ormond Beach, FL 32174 Phone: 386-383-7238 | |
Kyle Joseph Gilrain, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 570 Memorial Cir Ste 310, Ormond Beach, FL 32174 Phone: 386-290-2993 | |
Michael Chase, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 845 John Anderson Dr, Ormond Beach, FL 32176 Phone: 386-299-9919 |